Common sense and tumor treatment. A case of pilomatrical carcinoma in a 21-year-old patient with surprisingly rapid tumor progression

Pilomatrix carcinoma unveiled: a systematic review of clinical characteristics, pathogenesis, diagnostic puzzles, and management strategies

Pilomatrix carcinoma (PC) is a rare malignant adnexal tumor originating from follicular matrix cells primarily impacting Caucasian males. This review provides a comprehensive analysis of scientific literature on PC through an exploration of 206 cases reported between 1980 and 2024. We discuss the epidemiology, clinical presentation, histopathology, and diagnostic challenges of PC, and explore various treatment methods for this rare malignancy as well as their associated outcomes. Wide local excision (WLE) is the most common management method, but Mohs micrographic surgery (MMS) may yield superior margin control and lower risk of recurrence and metastasis. Our findings underscore the need for further studies with thoroughly documented follow-up in order to create standardized evidence-based management guidelines and reduce risk of recurrence and metastasis of this rare and aggressive tumor.

Giant Pilomatrix Carcinoma of the Thorax: An Uncommon and Clinically Misdiagnosed Tumor

Pilomatrix carcinoma is an unusual and aggressive malignant tumor deriving from follicular matrix cells and exhibiting a metastatic potential to lungs and regional lymph nodes in 10% of cases. We report the case of a 54-year-old male patient who presented with a biopsy-proven malignant pilomatrixoma of the thoracic region, which recurred multiple times after previous excisions. Due to the size of the tumor (28 by 22 cm), wide excision and axillary lymphadenectomy of levels I and II were performed, followed by reconstruction with a free deep inferior epigastric artery perforator flap and adjuvant radiotherapy. Owing to its rarity, this tumor can initially be misdiagnosed, resulting in delayed treatment and recurrences if inadequately excised. Also, large tumor size is correlated with a higher incidence of metastasis. High index of clinical suspicion and wide excision are recommended, along with the need of establishing oncological guidelines for better prognosis.

Challenges in the diagnosis and treatment of the malignant adnexal neoplasms of the head and neck

PURPOSE OF REVIEW

The current review is to present the current knowledge regarding epidemiology, diagnostics, and management of malignant adnexal neoplasms (MANs).

RECENT FINDINGS

Immunotherapy and gene-related therapies are still being developed as the methods of salvage treatment in advanced and disseminated cases: CACNA1S, ATP2A1, RYR1, and MYLK3, as well as p53 or the JAK/STAT pathways, may be therapeutic targets; the efficiency of talimogene laherparepvec and nivolumab is assessed.

SUMMARY

MANs are rare tumors, but due to the aging of population their incidence is increasing. Their clinical presentation is unspecific, which makes the diagnosis challenging. Histopathological assessment is difficult even for experienced pathologists. Mohs micrographic surgery or wide local excision are recommended to treat primary lesions. Adjuvant radiotherapy may be beneficial in case of insufficient or positive surgical margins, in nodal metastases, in selected types of MANs like sebaceous, trichilemmal, and pilomatrix carcinomas, and as the induction treatment in large tumors located in medically fragile or cosmetically important regions. The role of chemotherapy is not well defined; however, it is recommended in distant metastases. Immunotherapy can improve the prognosis in advanced stage of the disease.

Pilomatrixoma Recurring as Giant Form

Pilomatrixoma is a benign skin tumor that originates from the hair matrix. It usually appears in children and young adults and is preferably in the head and neck region. It clinically presents as an asymptomatic firm, solitary subcutaneous mass of less than 3 cm. When located in the preauricular area, it is often misdiagnosed as benign or malignant parotids, skin tumors, or sebaceous cysts. Its treatment of choice is surgery, and recurrence is due to incomplete excision. We present a case of a male referred to our hospital with a diagnosis of recurrent pilomatrixoma in its giant form. The lesion was fully excised with no signs of recurrence and no functional impairment.

Pilomatrical carcinosarcoma in the very elderly: A case report

Pilomatrical carcinosarcomas are very rare tumors. To the best of our knowledge, only nine cases diagnosed with pilomatrical carcinosarcomas have been reported. The present study reported on a case of pilomatrical carcinosarcoma in the posterior part of the left auricle of a 100-year-old male patient. The tumor histologically comprised the following two components: Pilomatrical carcinoma and undifferentiated spindle cell sarcoma. The pilomatrical carcinoma comprised atypical basaloid cells and shadow cells. The basaloid cells had basophilic cytoplasm, clear nucleoli and deeply stained nuclear chromatin. The undifferentiated spindle cell sarcoma comprised atypical spindle cells. Both components contained numerous mitotic cells. The boundary area between the carcinoma and sarcoma smoothly transitioned into each other. The carcinoma cells and a portion of the sarcoma cells were positive for β-catenin in the cytoplasm with or without the nuclei. These results suggested that the two components developed from the same origin.

Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Follicular Differentiation

Neoplasms derived from follicular tissue are extremely rare. Clinically, they are reported as non-symptomatic, slow-growing nodules. These lesions are mainly benign, but the malignant type can occur. Mainly middle-aged people (50-60 years of age) are affected. These carcinomas are mainly localized on the head and neck or torso. They can be locally aggressive and infiltrate surrounding tissue and metastasize to regional lymph nodes. In the minority of cases, distant metastases are diagnosed. Quick and relevant diagnosis is the basis of a treatment for all types of tumors. The patient's life expectancy depends on multiple prognostic factors, including the primary tumor size and its mitotic count. Patients should be referred to a specialized skin cancer center to receive optimal multidisciplinary treatment. This article tries to summarize all the information that is currently available about pathogenesis, diagnosis, and treatment methods of follicular tumors.